FAM 073 Approved for Optional Use SUPPLEMENTAL INFORMATION FOR REQUEST FOR RESTRAINING ORDER FAM 073 (March 25, 2013) Attorney or party without attorney (Name, State Bar Number, and address) Telephone No. Fax No. (optional): E - Mail address (optional): Attorney for (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF Street Address: Mailing Address: City and Zip Code: Branch Name: NAME OF PERSON ASKING FOR PROTECTION: NAME OF PERSON YOU WANT PROTECTION FROM: SUPPLEMENTAL INFORMATION FOR REQUEST FOR RESTRAINING ORDER CASE NUMBER : IN ORDER TO PROCESS YOUR REQUEST FOR A TEMPORARY RESTRAINING ORDER, THE COURT REQUIRES THE INFORMATION DESCRIBED BELOW: 1. Please provide further detail on the most recent incident of abuse such as what happened, when it happened, who did what to whom. Describe any injuries inflicted on you or the other person(s) to be protected. 2. Child custody orders are requested. Pursuant to Family Code 247 3064, custody orders can be granted only upon showing of harm to the child, a significant risk of harm to the child, or an immediate risk that the child will be removed from this state. Please provide further information on the reason for your request for child custody orders. American LegalNet, Inc. www.FormsWorkFlow.com FAM 073 Approved for Optional Use SUPPLEMENTAL INFORMATION FOR REQUEST FOR RESTRAINING ORDER FAM 073 (March 25, 2013) 3. Family Code 247 6211 specifies qualifications for Domestic Violence Restraining Orders. Please describe, in detail, the relationship you have with the other party that qualifies you for a Domestic Violence Restraining Order. 4. Is the allegation of abuse on the most recent act of Domestic Violence/Harassment/Abuse? If YES, explain why you waited until today to come to court. If NO, provide in detail the most recent incident of abuse such as what happened, when it happened, who did what to whom. Describe any injuries inflicted on you or the other person(s) to be protected. 5. Parts of your request are illegible or not understandable. 6. Other. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT YOUR NAME) (SIGN YOUR NAME) NAME OF PERSON ASKING FOR PROTECTION: NAME OF PERSON YOU WANT PROTECTION FROM: CASE NUMBER : American LegalNet, Inc. www.FormsWorkFlow.com